On January
24, 2013 the U.S. District Court for the District of Vermont approved a
settlement agreement in the case of Jimmo V. Sebelius. The case involved skilled care being denied
by contractors based on a rule-of thumb “Improvement Standard” – under which a
claim would be summarily denied due to a beneficiary’s lack of restoration
potential, even though the beneficiary did in fact require a covered level of
skilled care in order to prevent or slow further deterioration in his or her
clinical condition.
CMS agreed
to the settlement agreement. The
language in the settlement agreement did not modify or expand existing
eligibility requirements for receiving Medicare coverage.
On April 4,
2013 CMS issued a fact sheet that describes their plans to conduct the
following activities under the term of the settlement agreement.
1. Clarifying
Policy & Updating Program Manuals
2. Develop an
Education Campaign to inform stakeholders
3. Preform a
claims review to ensure beneficiaries are receiving care
CMS agrees
to complete the manual revisions and educational campaign by January 23, 2014.
For more
information please utilize the following link.
http://www.cms.gov/medicare/medicare-fee-for-service-payment/SNFPPS/downloads/jimmo-factsheet.pdf
No comments:
Post a Comment